In vitro fertilization (IVF) refers to the union of egg and sperm outside the body. In a broader sense, it is an assisted reproductive technology that offers hope to individuals and couples who are otherwise unable to conceive on their own. Since its development, millions of healthy children have been born worldwide as a result of IVF.
There are five major steps in the IVF process. The following provides a brief overview of the IVF process.

1. Ovarian stimulation

Injections of fertility medications called gonadotropins are taken daily by the woman which causes the growth of multiple follicles. At the same time, additional injections of medications called GnRH agonists or antagonists are also taken daily to prevent early ovulation. During ovarian stimulation, progress is monitored with a series of blood tests and vaginal ultrasounds. Lastly, an injection of a hormone called human chorionic gonadotropin (hCG) is taken to cause final maturation of the eggs in preparation for the egg retrieval procedure. The timing of hCG is determined by egg follicle sizes and blood estradiol levels.

2. Egg retrieval and sperm collection

36 hours following the hCG injection, patients will have their egg retrieval procedure. An ultrasound probe is placed in the vagina and a needle is passed along it, into the ovary. The eggs are collected from the follicles. Although there can be some discomfort, medication is given to minimize pain and the egg retrieval is generally well-tolerated. Most commonly, men will provide an ejaculated sperm sample for use, just before the egg retrieval procedure. In other situations, previously cryopreserved sperm, donor sperm or surgically retrieved sperm will be used for fertilization.

3. Fertilization and embryo culture

After a period of incubation in the lab, each egg is placed in a dish with a large number of moving sperm and fertilization is allowed to occur. If the sperm are low in number, movement or normal shape, a single sperm can be selected and injected into each egg using a technique called intracytoplasmic sperm injection. After eggs and sperm are combined, fertilization will occur. The resulting embryos are allowed to grow in the lab until ready for transfer into the uterus.

4. Embryo transfer

One or more embryos are placed into the uterus using a soft, flexible catheter or tube that is guided through the cervix by ultrasound. The discomfort of an embryo transfer procedure is similar to that of having a PAP test, but with a full bladder. After the embryo transfer, following 30 minutes of rest, patients return home and are advised to rest for the next day. Any good quality embryos remaining after the transfer may be cyropreserved for future use.

5. Progesterone supplementation and pregnancy test

Starting the day of the egg retrieval procedure, progesterone tablets are placed in the vagina three times a day in order to support a developing pregnancy. Occasionally, progesterone is given as an injection. A pregnancy test is performed 17 days after egg retrieval. If positive, progesterone is continued until an ultrasound is performed to assess the health of the pregnancy, which is usually done two to three weeks after a positive pregnancy test.

For a more detailed description of in vitro fertilization, please download our  Patient Guide (Guide Patient en français) or speak to your physician.

What goes on in the ART Laboratory

The Ottawa Hospital Department of Obstetrics and Gynecology Grand Rounds presentation by Dr. Marie Claude Léveillé, Scientific Director, Ottawa Fertility Centre, November 19, 2008. Webcast courtesy of Ontario Telemedicine Network.
Link to Webcast

FAQs

How do I know if IVF is right for me?

Following your investigation and diagnosis, your physician will discuss potential treatment options with you, which may include IVF. If IVF is recommended, you will have an hour long visit with your physician who will provide you with all the necessary information to allow you to make an informed decision regarding treatment.

IVF sounds very complex. How will I know if I'm doing everything correctly?

Every detail of your IVF cycle will be expertly managed by the physicians and nurses at the OFC. Patients undergoing IVF will attend a group education session and a one-on-one visit with a nurse prior to treatment. During treatment, all patients will receive detailed instructions regarding the administration and timing of all medications.

How much time will IVF treatment take?

Depending on the specific treatment protocol, an IVF treatment cycle can last several weeks. The active phase of treatment, from the start of ovarian stimulation to the embryo transfer, generally last two to three weeks.

Can I exercise during IVF?

While regular exercise is encouraged as part of a healthy lifestyle, the answer to this question must be individualized, depending on the type of exercise, your fitness level and your overall health. Please speak with your physician.

How successful is IVF?

The success rate of IVF depends on a number of factors, one of the most important being the woman's age. At the Ottawa Fertility Centre, our IVF success rates have been consistently above the Canadian average. Please speak with your physician for more detailed information.

If my first cycle of IVF isn't successful, how many more cycles will it take?

Each patient is unique, as is each IVF treatment cycle. Therefore, it is not possible to provide a general answer to this question. At the Ottawa Fertility Centre, each unsuccessful cycle is reviewed by the entire team of physicians and the scientific director in order to generate recommendations for future fertility treatment.